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Fertility Options for Transgender Men and Women

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Are you a transgender male or female interested in having genetically related children today? Or at some point in the future? Dr. Samuel Pang, Medical Director at IVF New England, has been treating gay and transgender men and women since 1998. He spoke with FertilityAuthority about options for preserving your fertility and building your family before and after transitioning.

Question: I’m going to transition, what are my options to have genetic children in the future.Answer: According to Pang, have a conversation with your physician and let them know you’d like to freeze your eggs or freeze your sperm before you undergo any type of treatment – surgery or hormonal – that may render you incapable of producing sperm or eggs in the future.

A man who has transitioned to a woman and has banked sperm can use the sperm with IUI if she is in a relationship with a woman. If she is in a relationship with a man or is single, she can use an egg donor and a gestational carrier.

A woman who has transitioned to a man and has frozen eggs can use donor or partner sperm and a gestational carrier if he is single or in a relationship with a man. If he is in a relationship with a woman, they can undergo reciprocal IVF, whereby the partner is inseminated with an embryo created by donor sperm and the frozen eggs.

Q: I’ve already started my transition with hormone therapy, but did not freeze my sperm or eggs prior. What's next?A: Unfortunately, not all doctors present options for fertility preservation before you transition. If hormone therapy is halted, there is the possibility that sperm production may resume and ovaries will ovulate again. What’s unknown, because this is a new field, is how long can you be on hormone therapy before it could potentially become reversible. “I have had transgender men who have been on testosterone therapy for up to 18 months, and when we stopped his testosterone therapy he began ovulating and menstruating, which then allowed us to stimulate his ovaries and retrieve his eggs,” Pang says. However many men are reluctant to stop testosterone therapy because it can be psychologically distressing; you’ve been living as a man, and now facial hair stops growing and you start menstruating. It’s an option, but it’s not ideal. That’s why it is so important to consider fertility preservation before you initiate the transition.

Q: I’ve had or will have surgery to remove my ovaries or testicles. Can I still have biological children?A: If the ovaries are you removed you’ll no longer produce eggs, and if the testicles are removed you’ll no longer produce sperm. That’s why it’s important to preserve your fertility prior to surgery. If you’ve already had surgery, egg donation or sperm donation is an option to build your family.

Q: I have a child under the age of 18 who is considering transitioning. What are options for preserving his or her fertility?A: Children are coming out and transitioning at younger ages. If the child is post puberty, eggs or sperm can be retrieved and frozen. “The biggest obstacle would be where young boys or girls are given medications to suppress puberty,” Pang says. “A trans girl would be given drugs to prevent her from undergoing puberty so her penis and testicles won’t grow and she won’t produce testosterone. If they don’t undergo puberty, that would prevent a huge challenge for fertility preservation.”

Q: Can a child under the age of 18 preserve his or her fertility?A: “Most recently I had a phone call with a mother of a 14-year-old transgender son who has been considering transition from a girl to a boy for the last five years, and he was thinking about preserving his eggs before he begins hormone therapy. That is great,” Pang says. “But there are issues because he’s still a minor. We treat minors who have cancer and need fertility preservation, so we’ll use that model.”

Q: How do I find a transgender-friendly fertility doctor?A: Not every fertility practice is GLBT friendly, so referrals are a good place to start. And Pang emphasizes you don’t want a fertility practice that simply treats the GLBT community because it’s good for business, you want a practice whose entire staff is welcoming and culturally sensitive.

Comments (23)

Hi, I'm a sixteen year old and I'm female to male transgender. I've been on testosterone for almost a year now and I know I'm going to stay on it into my adulthood. My primary concern is that by the time I will want to have kids in the future and go through IVF with my significant other my ovaries will no longer function. It's hard to know since there hasn't been much research on the affect of testosterone on teens into their adulthood. In the future I'd be willing to stop testosterone to allow my ovaries to try and function, but will that even be possible if I want kid around the age 25-28 if I'm on testerone now at 16.

I'm a 25 year old transman, and I want to know if I would be able to transfer my egg to my girlfriend later in life. I don't want to do any surgeries or anything, would I still be able to have eggs saved for her even if I'm having any change? She's still able to have kids herself but I wanted to put it in her once it gets fertilized so we can both have a child together. If that makes any sense.

I'm pre-t and thinking about having children of my own in the future. How much will it cost to freeze the egg currently? And I was also wondering if it were possible to be on testosterone for a while and then stop to hopefully be able to use the eggs and not have to pay a lot of money to freeze them instead

Hi I'm 14 year old and I'm a transgender boy.
I have always wanted to have children of my own one day.
I have also a girlfriend from Great Britain which is very worried about that I won't be able to make her pregnant one day.
I would love to know if there is any chances for me to have children of my own in the future even if I'm going to have surgery so I can become a male instead of staying a female whole my life.
My mum says that it is impossible for a transgender boy to have biological children in the future .
But I don't believe her.
Please tell me, is there any chance for me to have biological children in the future or not.....please I need to know

Thank you for reaching out with this question. Typically, it is recommended that you freeze your eggs prior to taking any of the hormones prescribed to transition. It depends on how far along you are in your transition process and how much of the medication you've already taken to determine whether or not you would be able to freeze after you've already started taking hormones. You would want to inquire further with your doctor or a fertility specialist to determine your options.

The reality is this is incredibly expensive and only the most wealthy of people period can afford this. No young adult can afford to spend an extra 2000 dollars a year to preserve their fertility. Its incredibly unfair to ask an 18 year old to end up spending thousands of dollars just so they can have kids one day. This is something the government should pay for tbh

Everyone is entitled to their opinion, so thank you for voicing yours. The reality is egg freezing averages about $10,000 per cycle, but with programs like EggBanxx, you can save money on that cost. Yearly storage of eggs is between $500-1,000 after the first year which is included with EggBanxx.

Hello im a 15 year old female to male transgender me and my mom have been talking about my future as far as kids i am not on testosterone yet but i plan to be on it bh the end of this year. If i start will i no longer be able to have a biological child? I would want for my partner to carry the child so an ivf procedure. But my concern is that testosterone might stop that from happening..? So should i hold off on transitioning? Also i have pcos so would that effect anything..?

It's so great that you are thinking about all this in advance and able to talk with your mom about it. One thing to consider is freezing your eggs before you start testosterone. I would recommend talking with a reproductive endocrinologist about egg freezing as well as your PCOS before you get started. If you'd like help finding a doctor who is transgender-friendly, please let me know. Happy to help. Best, Claire (claire@fertilityauthority.com)

hello I am a 26 year old male to female transsexual living in new York city, I started my hormone replacement treatment about a 2 years ago, I have always wanted to have children of my own and I think is time for me to start doing so,since all my sisters have children already and I feel lonely, I have a boyfriend who is more than happy that we have a baby,i want to know where in new York may I go and is transsexual friendly, so I can start my new path towards having a baby of my own using my own sperm...
thank you in advance.

Hi there, I am 23 years old transgendered female its been 2 years since i halted any sort of HMT to have the possibility of having a genetic child in the near future. I have visited a cryo bank in nyc and have had my sperm count evaluated after a year of me being off HMT i have a frozen vile but the last thing they told me was that i had a low sperm count so i plan to visit them again soon since i am 1 year additionally off HMR since that time. My thing is I am unsure if i want to go back to them, there is still so many questions left unanswered or things i am questioning. For example, I am would like to know if my future offspring is going to be affected in anyway due to me being in HMT for a long time? Is there any sound information available that an offspring of a woman like myself will not bear any defects due to HMT.

Those are really good questions, and I would like to help you get them all answered. Our Patient Care Advocates would be happy to connect you with a doctor in NYC who works with transgendered patients and can answer all your questions. Call or email at 855-955-2229 or carecoordinator@fertilityauthority.com. Best, Claire

I've been on testosterone for a year and a half. I was wondering if you could point me in the right direction for trans friendly doctors in the seattle area. I don't have a problem stopping hormones in order for my ovaries to possibly start working again.
Thank, rey

Absolutely, we can help you find a trans friendly fertility doctor. Please call our Patient Care Advocates toll-free at 855-955-2229 or email at carecoordinator@fertilityauthority.com. They can answer your questions and help you find a fertility doctor near you. Best, Claire

If you are transitioning to male, you may be able to freeze your eggs prior and then use donor sperm and a gestational carrier to have a baby. Would you like a referral to a reproductive endocrinologist who is LBGT friendly? If so, please call us at 855-955-2229 or email carecoordinator@fertilityauthority.com. Best, Claire

Hi.I'm 20 yeard old female and i want to transgender to male . and i want to know have children but without a donor or partner , i want my own ! if that possible or not ? would i have sperm or what ?? please response soon

Hi
I'm a 21 years old female transexual. I been wanting to have a family of my own since high school before I start transition. I have not undergo any type of hormone yet due to the matter of wanting to have children of my own. I decided to do my research online and found my way to this site and I am very happy and grateful to come across this site for help. I want to know how can I start this process and have a family of my own.
Thank You
Briseis Tilo